The Central Commission for Discipline Inspection criticized some competent authorities to "adhere to self -theft" and "unblocked the deception all the way"

On August 7th, at a very delicate time, the website of the Central Discipline Inspection Commission released the article "Sword Finger Change of Consumption Drugs, Admiral Self -theft Set, and Weaving Medical Insurance Fund Supervision Network".

Just last week, the National Health and Health Commission and the State Medical Insurance Bureau broke out of violations of laws and disciplines: Chao Hua, a second -level inspector of the General Office of the National Health and Health Commission, and the director of the original brain defense committee office, and the Office of the Office of the Medical Insurance Bureau (Reform Office of the Reform Office (Reform Office ) Director Ding Wenjun, Qian Juncheng, the commissioner of the Propaganda Information Department of the China Medical Insurance Research Association, was successively investigated.

It seems that the competent authorities and grasping the cow nose seem to correspond to the "adventure self -theft" in the aforementioned issues of the Central Commission for Discipline Inspection.

Since the beginning of 2019, the focus of the focus of fraudulent behavior has achieved phased results. However, after a detailed analysis of the Central Commission for Discipline Inspection, it was found that the occurrence of deceitful insurance behaviors, although some private and even public hospitals, are more importantly in the medical and medical insurance management system. The criminals have the opportunity.

This article issued by the Central Commission for Discipline Inspection, pointing out the essence of this violation of the law: it is related to the corruption and style of party members and leading cadres.

Fantastic cheating medical insurance fund

How much thought did the illegal hospital spend in order to deceive the medical insurance fund?

In April of this year, the Medical Insurance Bureau of Tongji Hospital affiliated to the Tongji Medical College of Huazhong University of Science and Technology was notified: From January 2017 to September 2020, Tongji Hospital deceived the medical insurance fund of 23.3436 million through the method of changing and high -value medical consumables of the orthopedic orthopedic department. Yu Yuan.

The high -value consumables are replaced, that is, the second charging is used: the cheap consumables are used, and then the expensive consumables in the medical insurance directory are used to bill; Report medical expenses. In addition, the flight inspection also discovered 91.741 million yuan in other suspected use of medical insurance in 2021.

In the Chinese environment, "Tongji" has the beautiful meaning of "together in the same boat", so there are many hospitals called "Tongji". The Hunan Medical Insurance Bureau has also seized the local "Tongji Hospital" fraud cases in the past year.

In September 2021, the Hunan Xiangxi Prefecture Intermediate People's Court announced the survey results of the local "Phoenix for the People's Tongji Hospital": from July 2016 to July 2018, through the empty bed, extend the number of hospitalization days, false medication and other means, etc. , Phoenix deceived 5.69 million yuan in medical insurance funds for Minzhiji Hospital.

It is worth noting that the above is not a case.

In May this year, the National Medical Insurance Bureau issued the "Announcement of Flight Inspection of the 2021 Medical Insurance Fund", revealing the results of the 68 designated medical institutions in 29 provinces across the country, of which there were many medical institutions that used medical insurance funds in violation of regulations. Among the 68 scheduled medical institutions inspected:

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59 have the problems of repeating charges, over -standard charges, and decomposition of project charges;

50 problems with stringing drugs, medical consumables, and diagnosis and treatment items;

45 have the problems of over -diagnosis and treatment, excessive examination, excess medicine, and repeated medicine;

52 existing problems that include medical expenses that do not belong to the scope of medical insurance funds into the medical insurance fund settlement;

14 have the problem of decomposing hospitalization and hanging beds;

54 problems such as super -medical insurance payment limited medication, unqualified diagnosis and treatment services, inconsistency of drug consumables, virtual charges, and other unreasonable charges.

"Admissions self -theft" is the key

Regarding the bad behavior in the medical system, the Discipline Inspection Commission directly clarified that the "unimpeded" of the road to defraud the road is that the competent authority is "sticking to self -theft."

Tuyuan Central Commission for Discipline Inspection Committee State Supervision Commission website

Chen Yuejun, former director of the Hunan Medical Maternity Insurance Management Service Bureau, Li Xun, former director of the Medical Security Information Center of the Xiangtan Medical Insurance Bureau, and Luo Xichun, the former director of the Fund Inspection Center of the Medical Insurance Bureau, is very typical.

A hospital with only more than 20 beds in Xiangtan's local family gained Chen Yuejun's "platform preference" by sending money to Chen Yuejun, and was included in the designated medical unit of kidney transplant anti -exclusive drugs. From June 2016 to May 2018, the hospital deceived more than 13 million yuan in medical insurance funds through hanging beds, skewers, and fictional projects.

In the process, Li Xun used the loopholes of the medical insurance system to help the hospital directly enters the patient's information in the system, avoid expert review, and obtain a large number of medical insurance subsidies in violation of regulations. The inspection center found that the hospital's accounts did not match, the drug exchange drugs, and the consumption of card consumption, but Luo Xichun, the former director of the inspection center, was also bought.

In this way, after investigation by the Hunan Provincial Commission for Discipline Inspection, more than 30 public officials in Xiangtan received the benefits of many local private medical and pharmaceutical institutions, and condoned these institutions to large sets.

The "nest case" of the medical insurance system has appeared in many places.

In October 2021, the Sichuan Provincial Discipline Inspection Commission announced the problem of many "first-leaders" in the medical and health field involving bribery. Forces to help nine agents, and receive a total of more than 21.18 million yuan in bribes.

Almost at the same time, the disciplinary inspection committee of the Laibin City, Guangxi Zhuang Autonomous Region announced a crowd case: Zhou Fang, the former dean of the Laibin City People's Hospital of Guangxi Zhuang Autonomous Region, was abducted and wrote a "explanation material" to the kidnapper, which caused a nest involved in 76 people. Cases: A number of officials in the medical system cooperated to interoperate with related medicines and equipment salespersons. After investigation, the case involved an amount of more than 50 million yuan.

In the past, it was generally believed that private hospitals were more likely to violate the law, but huge cases of fraud in recent years were public hospitals.All localities are trying to start from the regulatory authorities to strictly investigate the rituals of self -theft.For example, the Commission for Discipline Inspection of Changyi City, Shandong Province urged the Municipal Medical Insurance Bureau to sort out 784 vocational responsibilities of 40 sectors; the Guanyun County Discipline Inspection Commission of Jiangsu Province strictly investigated the inaction, slow actions, and chaos of the medical insurance department;The Committee and the Municipal Medical Insurance Bureau explored the establishment of a third -party supervision center for the medical insurance fund.

From anti -corruption to the medical system to the medical insurance system, the difference between the word is very different.

### Medical insurance system Anti -corruption ## Party members and cadres corruption#

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